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SO2023780 - BCaMonitor - Case 1 - Question 1

Henry with intermediate-risk NMIBC finds follow-up cystoscopies burdensome. What now?

Henry, 70 years old, used to work as a creative director in a chocolate factory. Once, he designed chocolates that looked like broccoli. Too bad, they were not favoured by the clients…

He was initially diagnosed with a solitary small Ta low-grade (LG) tumour. He received 1 immediate chemotherapy instillation after transurethral resection of the bladder tumour (TURBT).

Follow-up cystoscopy after 6 months shows a 1 cm papillary tumour and TURBT is performed. Visual appearance suggests a low grade and he received again 1 immediate chemotherapy instillation. The pathology report confirms urothelial cancer pTa LG (muscle in specimen, no LVI).

He received mitomycin C instillations for 1 year. In the meantime, no recurrences were detected during follow-up.

His follow-up visit at 12 months post-TURBT: 
•    Cystoscopy: negative
•    Cytology: negative

The patient indicated he finds multiple cystoscopies burdensome.
 
Which option for surveillance would you propose to this patient (assuming all of the below options are available and fully covered for the patient)?
* if negative, cystoscopy another 6 months later; if positive, cystoscopy immediately